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Afsar B, Afsar RE, Caliskan Y, Lentine KL. A holistic review of sodium intake in kidney transplant patients: More questions than answers. Transplant Rev (Orlando) 2024; 38:100859. [PMID: 38749098 DOI: 10.1016/j.trre.2024.100859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 05/09/2024] [Accepted: 05/10/2024] [Indexed: 06/16/2024]
Abstract
Kidney transplantation (KT) is the best treatment option for end-stage kidney disease (ESKD). Acute rejection rates have decreased drastically in recent years but chronic kidney allograft disease (CKAD) is still an important cause of allograft failure and return to dialysis. Thus, there is unmet need to identify and reverse the cause of CKAD. Additionally, cardiovascular events after KT are still leading causes of morbidity and mortality. One overlooked potential contributor to CKAD and adverse cardiovascular events is increased sodium/salt intake in kidney transplant recipients (KTRs). In general population, the adverse effects of high sodium intake are well known but in KTRs, there is a paucity of evidence despite decades of experience with KT. Limited research showed that sodium intake is high in most KTRs. Moreover, excess sodium intake is associated with elevated blood pressure and albuminuria in some studies involving KTRs. There is also experimental evidence suggesting that increased sodium intake is associated with histologic graft damage. Critical knowledge gaps still remain, including the exact amount of sodium restriction needed in KTRs to optimize outcomes and allograft survival. Additionally, best methods to measure sodium intake and practices to follow-up are not clarified in KTRs. To meet these deficits, prospective long term studies are warranted in KTRs. Moreover, preventive measures must be determined and implemented both at individual and societal levels to achieve sodium restriction in KTRs.
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Affiliation(s)
- Baris Afsar
- Suleyman Demirel University, School of Medicine, Department of Nephrology, 32260, Cunur, Isparta, Türkiye; Saint Louis University, School of Medicine, Division of Nephrology, St. Louis, MO, USA.
| | - Rengin Elsurer Afsar
- Suleyman Demirel University, School of Medicine, Department of Nephrology, 32260, Cunur, Isparta, Türkiye; Saint Louis University, School of Medicine, Division of Nephrology, St. Louis, MO, USA
| | - Yasar Caliskan
- Saint Louis University, School of Medicine, Division of Nephrology, St. Louis, MO, USA
| | - Krista L Lentine
- Saint Louis University, School of Medicine, Division of Nephrology, St. Louis, MO, USA
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Lonardo MS, Guida B, Cacciapuoti N, Chiurazzi M, Pacella D, Cataldi M. Evidence That Skeletal Muscles Modulate HDL-Cholesterol in Metabolic Healthy Young Adults. Nutrients 2024; 16:1110. [PMID: 38674801 PMCID: PMC11054046 DOI: 10.3390/nu16081110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/06/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024] Open
Abstract
The aim of this study was to investigate whether skeletal muscle (SM) mass correlates with plasma lipids in metabolic healthy young adults. The study was designed as a retrospective observational monocentric study. Data on plasma lipids and SM mass of subjects attending our institution from 1999 to 2014 were analyzed. Inclusion criteria were being 18-45 years old and in apparently good health. SM mass was evaluated by bioelectrical impedance analysis (BIA) using the equation proposed by Janssen and normalized to height as skeletal muscle index (SMI: SM mass/height2). The association between SMI and plasma lipids levels was examined using a crude and adjusted linear regression model including age, sex, BMI and waist circumference as additional covariates. The study population consisted of 450 subjects (273 females) without metabolic syndrome (12.2% with normal body weight, 33.1% overweight, and 54.7% with obesity). SMI, total-cholesterol, LDL-cholesterol, and Triglycerides were higher, whereas HDL-cholesterol was lower in overweight and obese patients as compared with normal weight subjects. SMI was inversely associated with HDL-cholesterol in female patients with obesity but not in male patients with obesity, in normal- or over-weight subjects (p < 0.05). These results suggest that changes in SM mass occurring in obesity could have a role in worsening lipid profile with special reference to HDL-cholesterol.
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Affiliation(s)
- Maria Serena Lonardo
- Physiology Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University of Naples, 80131 Naples, Italy; (M.S.L.); (B.G.); (N.C.); (M.C.)
| | - Bruna Guida
- Physiology Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University of Naples, 80131 Naples, Italy; (M.S.L.); (B.G.); (N.C.); (M.C.)
| | - Nunzia Cacciapuoti
- Physiology Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University of Naples, 80131 Naples, Italy; (M.S.L.); (B.G.); (N.C.); (M.C.)
| | - Martina Chiurazzi
- Physiology Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University of Naples, 80131 Naples, Italy; (M.S.L.); (B.G.); (N.C.); (M.C.)
| | - Daniela Pacella
- Department of Public Health, Federico II University of Naples, 80131 Naples, Italy;
| | - Mauro Cataldi
- Division of Pharmacology, Department of Neuroscience, Reproductive Sciences and Dentistry, Federico II University of Naples, 80131 Naples, Italy
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Lonardo MS, Cacciapuoti N, Chiurazzi M, Di Lauro M, Guida B, Damiano S, Cataldi M. Combined use of handgrip strength and hemoglobin as markers of undernutrition in patients with stage 3-5 chronic kidney disease. Nutr Metab Cardiovasc Dis 2023; 33:2169-2178. [PMID: 37544868 DOI: 10.1016/j.numecd.2023.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 05/31/2023] [Accepted: 06/19/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND AND AIMS The early identification of undernourished patients with CKD could help instating appropriate nutritional intervention before the full development of the threatening condition known as Protein Energy Wasting (PEW). Handgrip strength (HGS) and blood hemoglobin (Hb) concentration are two parameters considered representative of nutritional status but not included among the criteria for PEW diagnosis. In the present work we investigated whether they could help identifying CKD patients at risk of undernutrition. METHODS AND RESULTS We performed a two-step cluster analysis to classify a cohort of 71 stage 3-5 CKD patients, none of which with PEW, according to their Hb concentration and dominant-hand HGS. Two clusters were finely separated using this method. When we compared the two groups for main body composition and nutritional variables by using t-test statistics or Mann-Whitney test, as appropriate, we found significant differences in PhA, ECW/TBW, ASMI, serum iron. Then we stratified our population by gender and performed cluster analysis as well. PhA, ECW/TBW were still significantly different in the two clusters both in M and in F, while serum iron concentration only in males and ASMI only in females. CONCLUSION These results suggest that either in male than in female Hb concentration and HGS may distinguish two subgroups of CKD patients with different nutritional status and disease severity. Patient belonging to either of these cluster can be easily identified by using the HGS/Hb ratio which represents the HGS normalized per gr Hb.
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Affiliation(s)
- Maria Serena Lonardo
- Department of Clinical Medicine and Surgery, Physiology Nutrition Unit, Federico II University of Naples, Italy.
| | - Nunzia Cacciapuoti
- Department of Clinical Medicine and Surgery, Physiology Nutrition Unit, Federico II University of Naples, Italy
| | - Martina Chiurazzi
- Department of Clinical Medicine and Surgery, Physiology Nutrition Unit, Federico II University of Naples, Italy
| | - Mariastella Di Lauro
- Department of Clinical Medicine and Surgery, Physiology Nutrition Unit, Federico II University of Naples, Italy
| | - Bruna Guida
- Department of Clinical Medicine and Surgery, Physiology Nutrition Unit, Federico II University of Naples, Italy
| | - Simona Damiano
- Department of Clinical Medicine and Surgery, Physiology Nutrition Unit, Federico II University of Naples, Italy
| | - Mauro Cataldi
- Department of Neuroscience, Reproductive Sciences and Dentistry, Division of Pharmacology, Federico II University of Naples, Italy
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4
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Evolving Concepts on Inflammatory Biomarkers and Malnutrition in Chronic Kidney Disease. Nutrients 2022; 14:nu14204297. [PMID: 36296981 PMCID: PMC9611115 DOI: 10.3390/nu14204297] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/30/2022] [Accepted: 10/07/2022] [Indexed: 11/11/2022] Open
Abstract
While patient care, kidney replacement therapy, and transplantation techniques for chronic kidney disease (CKD) have continued to progress, the incidence of malnutrition disorders in CKD appears to have remained unchanged over time. However, there is now a better understanding of the underlying pathophysiology according to the disease background, disease stage, and the treatment received. In CKD patients, the increased production of proinflammatory cytokines and oxidative stress lead to a proinflammatory milieu that is at least partially responsible for the increased morbidity and mortality in this patient population. New insights into the pathogenic role of innate immunity and the proinflammatory cytokine profile, characterized, for instance, by higher levels of IL-6 and TNF-α, explain some of the clinical and laboratory abnormalities observed in these patients. In this article, we will explore currently available nutritional-inflammatory biomarkers in distinct CKD populations (hemodialysis, peritoneal dialysis, transplantation) with a view to evaluating their efficacy as predictors of malnutrition and their involvement in the common proinflammatory process. Although there is a direct relationship between inflammatory-nutritional status, signs and symptoms [e.g., protein-energy wasting (PEW), anorexia], and comorbidities (e.g., atheromatosis, atherosclerosis), we are in need of clearly standardized markers for nutritional-inflammatory assessment to improve their performance and design appropriate bidirectional interventions.
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Guida B, Maro MD, Lauro MD, Lauro TD, Trio R, Santillo M, Belfiore A, Memoli A, Cataldi M. Identification of sarcopenia and dynapenia in CKD predialysis patients with EGWSOP2 criteria: An observational, cross-sectional study. Nutrition 2020; 78:110815. [PMID: 32480255 DOI: 10.1016/j.nut.2020.110815] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 01/14/2020] [Accepted: 03/01/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Using the new European Working Group on Sarcopenia in Older People (EWGSOP2) criteria, we identified sarcopenic and dynapenic patients in a cohort of predialysis patients with chronic kidney disease (CKD), and evaluated their clinical and laboratory characteristics. METHODS The study population consisted of 85 (55 men) clinically stable predialysis CKD patients (92.9% in stages 3-5), with a median age of 65.0 (52.5-72.0) y. We classified as sarcopenic the patients with handgrip strength (HGS) and muscle mass both lower than the respective EWGSOP2 cutoff values and as dynapenic those in whom only HGS was less than these reference values. HGS was measured with a hand dynamometer, whereas muscle mass was measured by bioimpedance analysis. Renal function was evaluated as Modification of Diet in Renal Disease estimated glomerular filtration rate. RESULTS The prevalence of sarcopenia and dynapenia was, respectively, 7.1% and 17.6%. As reported in previous studies, serum albumin and hemoglobin were lower in sarcopenic patients than in patients with preserved muscle mass and strength. However, unlike in these studies, sarcopenia prevalence did not increase with CKD stage, and estimated glomerular filtration rate was similar between groups. Moreover, no difference was identified in any of the aforementioned parameters between dynapenic patients and patients with preserved muscle mass and strength. CONCLUSIONS The EWGSOP2 criteria identified sarcopenia in CKD with a prevalence similar to previous diagnostic criteria. In addition, they found that dynapenia was highly prevalent. Nevertheless, the EWGSOP2 criteria could be better adapted to CKD patients to improve their ability to detect high-risk sarcopenic and dynapenic patients.
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Affiliation(s)
- Bruna Guida
- Department of Clinical Medicine and Surgery, Physiology Nutrition Unit, Federico II University of Naples, Naples, Italy.
| | - Martina Di Maro
- Department of Clinical Medicine and Surgery, Physiology Nutrition Unit, Federico II University of Naples, Naples, Italy
| | - Mariastella Di Lauro
- Department of Clinical Medicine and Surgery, Physiology Nutrition Unit, Federico II University of Naples, Naples, Italy
| | - Teresa Di Lauro
- Department of Clinical Medicine and Surgery, Physiology Nutrition Unit, Federico II University of Naples, Naples, Italy
| | - Rossella Trio
- Department of Clinical Medicine and Surgery, Physiology Nutrition Unit, Federico II University of Naples, Naples, Italy
| | - Mariarosaria Santillo
- Department of Clinical Medicine and Surgery, Physiology Nutrition Unit, Federico II University of Naples, Naples, Italy
| | - Annamaria Belfiore
- Department of Clinical Medicine and Surgery, Physiology Nutrition Unit, Federico II University of Naples, Naples, Italy
| | - Andrea Memoli
- Department of Public Health, Nephrology Section, Federico II University of Naples, Naples, Italy
| | - Mauro Cataldi
- Department of Neuroscience, Reproductive Sciences and Dentistry, Division of Pharmacology, Federico II University of Naples, Naples, Italy
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Guida B, Trio R, Di Maro M, Memoli A, Di Lauro T, Belfiore A, Santillo M, Cataldi M. Prevalence of obesity and obesity-associated muscle wasting in patients on peritoneal dialysis. Nutr Metab Cardiovasc Dis 2019; 29:1390-1399. [PMID: 31668791 DOI: 10.1016/j.numecd.2019.05.057] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 04/30/2019] [Accepted: 05/08/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIMS A progressive decrease in muscle mass until full-blown sarcopenia may occur in patients on peritoneal dialysis (PD) and worsen their life quality and expectancy. Here we investigate the prevalence of obesity and obesity-associated muscle wasting in PD patients. PATIENTS AND METHODS The study design was observational, cross sectional. Body composition was assessed with BIA and BIVA in 88 PD patients (53.4 ± 13.1 years; 67% male). Patients with obesity and/or with reduced muscle mass were identified using FMI and SM/BW cutoff values, respectively. Inflammatory status was assessed by measuring CRP and fibrinogen blood levels. RESULTS A total of 44.3% of the patients showed a reduced muscle mass (37.5% moderate and 6.8% severe). The prevalence of obesity was 6.1%, 81.8%, and 100% in patients with normal, moderately, and severely reduced muscle mass, respectively (p < 0.05). Of the total, 15.2% of the patients with normal muscle mass, 18.4% of those with moderately reduced muscle mass, and 66.7% of those with severely reduced muscle mass had diabetes. The prevalence of severe muscle mass loss was higher in those with diabetes than in those without diabetes (22.2% vs. 2.8%, p < 0.05). Patients with obesity-associated muscle wasting showed higher fibrinogen (613.9 ± 155.1 vs. 512.9 ± 159.5 mg/dL, p < 0.05) and CPR (1.4 ± 1.3 vs. 0.6 ± 0.8 mg/dL, p < 0.05) blood concentrations than those with normal body composition. CONCLUSION Obesity and diabetes were strongly associated with muscle mass loss in our PD patients. It remains to be established whether prevention of obesity with nutritional interventions can halt the occurrence of muscle mass loss in patients on PD.
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Affiliation(s)
- Bruna Guida
- Department of Clinical Medicine and Surgery, Physiology Nutrition Unit, Federico II University of Naples, Italy.
| | - Rossella Trio
- Department of Clinical Medicine and Surgery, Physiology Nutrition Unit, Federico II University of Naples, Italy
| | - Martina Di Maro
- Department of Clinical Medicine and Surgery, Physiology Nutrition Unit, Federico II University of Naples, Italy
| | - Andrea Memoli
- Department of Public Health, Nephrology Section, Federico II University of Naples, Italy
| | - Teresa Di Lauro
- Department of Clinical Medicine and Surgery, Physiology Nutrition Unit, Federico II University of Naples, Italy
| | - Annamaria Belfiore
- Department of Clinical Medicine and Surgery, Physiology Nutrition Unit, Federico II University of Naples, Italy
| | - Mariarosaria Santillo
- Department of Clinical Medicine and Surgery, Physiology Nutrition Unit, Federico II University of Naples, Italy
| | - Mauro Cataldi
- Department of Neuroscience, Reproductive Sciences and Dentistry, Division of Pharmacology, Federico II University of Naples, Italy
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Sabbatini M, Ferreri L, Pisani A, Capuano I, Morgillo M, Memoli A, Riccio E, Guida B. Nutritional management in renal transplant recipients: A transplant team opportunity to improve graft survival. Nutr Metab Cardiovasc Dis 2019; 29:319-324. [PMID: 30782507 DOI: 10.1016/j.numecd.2019.01.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 01/02/2019] [Accepted: 01/02/2019] [Indexed: 12/27/2022]
Abstract
AIMS The nutritional management of renal transplant recipients (RTR) represents a complex problem either because the recovery of renal function is not complete and for the appearance of "unavoidable" metabolic side effects of immunosuppressive drugs. Nevertheless, it remains a neglected problem, whereas an appropriate dietary intervention could favorably affect graft survival. DATA SYNTHESIS Renal transplantation is associated with steroids and calcineurin inhibitors administration, liberalization of diet after dialysis restrictions, and patients' better quality of life. These factors predispose, from the first months after surgery, to body weight gain, enhanced post transplant diabetes, hyperlipidemia, metabolic syndrome, with negative consequences on graft outcome. Unfortunately, specific guidelines about this topic and nutritional counseling are scarce; moreover, beyond the low adherence of patients to any dietary plan, there is a dangerous underestimation of the problem by physicians, sometimes with inadequate interventions. A prompt and specific nutritional management of RTR can help prevent or minimize these metabolic alterations, mostly when associated with careful and repeated counseling. CONCLUSIONS A correct nutritional management, possibly tailored to enhance patients' motivation and adherence, represents the best preventive maneuver to increase patients' life and probably improve graft survival, at no cost and with no side effects.
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Affiliation(s)
- M Sabbatini
- Department of Public Health, University Federico II of Naples, Via Pansini 5, 80131, Naples, Italy.
| | - L Ferreri
- Department of Public Health, University Federico II of Naples, Via Pansini 5, 80131, Naples, Italy
| | - A Pisani
- Department of Public Health, University Federico II of Naples, Via Pansini 5, 80131, Naples, Italy
| | - I Capuano
- Department of Public Health, University Federico II of Naples, Via Pansini 5, 80131, Naples, Italy
| | - M Morgillo
- Department of Clinical Medicine and Surgery, University Federico II of Naples, Via Pansini 5, 80131, Naples, Italy
| | - A Memoli
- Department of Public Health, University Federico II of Naples, Via Pansini 5, 80131, Naples, Italy
| | - E Riccio
- Department of Public Health, University Federico II of Naples, Via Pansini 5, 80131, Naples, Italy
| | - B Guida
- Department of Clinical Medicine and Surgery, University Federico II of Naples, Via Pansini 5, 80131, Naples, Italy
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Guida B, Parolisi S, Coco M, Ruoppo T, Veccia R, di Maro M, Trio R, Memoli A, Cataldi M. The impact of a nutritional intervention based on egg white for phosphorus control in hemodialyis patients. Nutr Metab Cardiovasc Dis 2019; 29:45-50. [PMID: 30459073 DOI: 10.1016/j.numecd.2018.09.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 09/18/2018] [Accepted: 09/20/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Here we describe a dietary intervention for hyperphosphatemia in dialysis patients based on the partial replacement of meat and fish, which are one of the main sources of alimentary phosphorous, with egg white, a virtually phosphorous-free protein source. This intervention aims to reduce phosphorous intake without causing protein wasting. PATIENTS AND METHODS As many as 23 hyperphosphatemic patients (15 male and 8 female, mean age 53.0 ± 10.0 years) on chronic standard 4 h, three times weekly, bicarbonate hemodialysis were enrolled in this open-label, randomized controlled trial. Patients in the intervention group were instructed to replace fish or meat with egg white in three meals a week for three months whereas diet was unchanged in the control group. RESULTS Serum phosphate concentrations were significantly lower in the intervention group than in controls after three (4.9 ± 1.0 vs 6.6 ± 0.8; p < 0.001) but not after one month of treatment. Phosphate concentrations decreased more from baseline in the intervention than in the control group both after one (-1,2 ± 1,1 vs 0,5 ± 1,1; p = 0.004) and after three (-1,7 ± 1,1 vs -0,6 ± 1,1; p < 0.001) months of follow-up. No change either in body weight or in body composition assessed with bioelectrical impedance analysis or in serum albumin concentration was observed in either group. CONCLUSION The partial replacement of meat and fish with egg white induces a significant decrease in serum phosphate without causing protein malnutrition and could represent a useful instrument to control serum phosphate levels in hemodialysis patients. CLINICALTRIALS. GOV IDENTIFIER NCT03236701.
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Affiliation(s)
- B Guida
- Department of Clinical Medicine and Surgery, Physiology Nutrition Unit, Federico II University of Naples, Italy; Federico II University Hospital, Naples, Italy.
| | - S Parolisi
- Department of Clinical Medicine and Surgery, Physiology Nutrition Unit, Federico II University of Naples, Italy
| | - M Coco
- Department of Clinical Medicine and Surgery, Physiology Nutrition Unit, Federico II University of Naples, Italy
| | - T Ruoppo
- Department of Clinical Medicine and Surgery, Physiology Nutrition Unit, Federico II University of Naples, Italy
| | - R Veccia
- Department of Clinical Medicine and Surgery, Physiology Nutrition Unit, Federico II University of Naples, Italy
| | - M di Maro
- Department of Clinical Medicine and Surgery, Physiology Nutrition Unit, Federico II University of Naples, Italy
| | - R Trio
- Department of Clinical Medicine and Surgery, Physiology Nutrition Unit, Federico II University of Naples, Italy; Federico II University Hospital, Naples, Italy
| | - A Memoli
- Department of Public Health, Nephrology Section, Federico II University of Naples, Italy; Federico II University Hospital, Naples, Italy
| | - M Cataldi
- Department of Neuroscience, Reproductive Sciences and Dentistry, Division of Pharmacology, Federico II University of Naples, Italy; Federico II University Hospital, Naples, Italy
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Guida B, Cataldi M, Busetto L, Aiello ML, Musella M, Capone D, Parolisi S, Policastro V, Ragozini G, Belfiore A. Predictors of fat-free mass loss 1 year after laparoscopic sleeve gastrectomy. J Endocrinol Invest 2018; 41:1307-1315. [PMID: 29574529 DOI: 10.1007/s40618-018-0868-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 03/09/2018] [Indexed: 12/13/2022]
Abstract
PURPOSE Laparoscopic sleeve gastrectomy (LSG) is one of the most frequently performed bariatric surgery interventions because of its safety and efficacy. Nevertheless, concerns have been raised on its detrimental effect on patient nutritional state that can ultimately lead to the loss of fat-free mass (FFM). There is interest in identifying predictors for the early identification of patients at risk of this highly unwanted adverse because they could benefit of nutritional preventive interventions. Therefore, we investigated whether anthropometric parameters, body composition or resting energy expenditure (REE) measured before surgery could predict FFM loss 1 year after LSG. METHODS Study design was retrospective observational. We retrieved data on body weight, BMI, body composition and REE before and 1 year after LSG from the medical files of 36 patients operated on by LSG at our institutions. Simple regression, the Oldham's method and multilevel analysis were used to identify predictors of FFM loss. RESULTS Averaged percentage FFM loss 1 year after LSG was 17.0 ± 7.7% with significant differences between sexes (20.8 ± 6.6 in males and 12.2 ± 6.1% in females, p < 0.001). FFM loss was strongly predicted by pre-surgery FFM and this effect persisted also after correcting for the contribution of sex. CONCLUSIONS High FFM values before surgery predict a more severe FFM loss after LSG. This factor could also account for the higher FFM loss in men than in women. Our finding could help in the early identification of patient requiring a nutritional support after LSG.
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Affiliation(s)
- B Guida
- Division of Physiology, Department of Clinical Medicine and Surgery, Federico II University of Naples, Via Pansini n°5, 80131, Naples, Italy.
- Federico II University Hospital, Naples, Italy.
| | - M Cataldi
- Federico II University Hospital, Naples, Italy
- Division of Pharmacology, Department of Neuroscience, Reproductive Sciences and Dentistry, Federico II University of Naples, Naples, Italy
| | - L Busetto
- Department of Medicine, University of Padova, Padua, Italy
| | - M L Aiello
- Division of Physiology, Department of Clinical Medicine and Surgery, Federico II University of Naples, Via Pansini n°5, 80131, Naples, Italy
| | - M Musella
- Federico II University Hospital, Naples, Italy
- Division of Surgery, Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - D Capone
- Federico II University Hospital, Naples, Italy
| | - S Parolisi
- Division of Physiology, Department of Clinical Medicine and Surgery, Federico II University of Naples, Via Pansini n°5, 80131, Naples, Italy
| | - V Policastro
- Division of Statistics, Department of Political Science, Federico II University of Naples, Naples, Italy
| | - G Ragozini
- Division of Statistics, Department of Political Science, Federico II University of Naples, Naples, Italy
| | - A Belfiore
- Division of Physiology, Department of Clinical Medicine and Surgery, Federico II University of Naples, Via Pansini n°5, 80131, Naples, Italy
- Federico II University Hospital, Naples, Italy
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10
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Prado NJ, Ferder L, Manucha W, Diez ER. Anti-Inflammatory Effects of Melatonin in Obesity and Hypertension. Curr Hypertens Rep 2018; 20:45. [PMID: 29744660 DOI: 10.1007/s11906-018-0842-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW Here, we review the known relations between hypertension and obesity to inflammation and postulate the endogenous protective effect of melatonin and its potential as a therapeutic agent. We will describe the multiple effects of melatonin on blood pressure, adiposity, body weight, and focus on mitochondrial-related anti-inflammatory and antioxidant protective effects. RECENT FINDINGS Hypertension and obesity are usually associated with systemic and tissular inflammation. The progressive affection of target-organs involves multiple mediators of inflammation, most of them redundant, which make anti-inflammatory strategies ineffective. Melatonin reduces blood pressure, body weight, and inflammation. The mechanisms of action of this ancient molecule of protection involve multiple levels of action, from subcellular to intercellular. Mitochondria is a key inflammatory element in vascular and adipose tissue and a potential pharmacological target. Melatonin protects against mitochondrial dysfunction. Melatonin reduces blood pressure and adipose tissue dysfunction by multiple anti-inflammatory/antioxidant actions and provides potent protection against mitochondria-mediated injury in hypertension and obesity. This inexpensive and multitarget molecule has great therapeutic potential against both epidemic diseases.
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Affiliation(s)
- Natalia Jorgelina Prado
- Instituto de Medicina y Biología Experimental de Cuyo (IMBECU), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Mendoza, Argentina
| | - León Ferder
- Pediatric Department Nephrology Division, Miller School of Medicine, University of Miami, Florida, USA
| | - Walter Manucha
- Instituto de Medicina y Biología Experimental de Cuyo (IMBECU), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Mendoza, Argentina.,Área de Farmacología, Facultad de Ciencias Médicas, Universidad Nacional de Cuyo, Mendoza, Argentina
| | - Emiliano Raúl Diez
- Instituto de Medicina y Biología Experimental de Cuyo (IMBECU), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Mendoza, Argentina. .,Instituto de Fisiología, Facultad de Ciencias Médicas, Universidad Nacional de Cuyo, Centro Universitario, CP 5500, Mendoza, Argentina.
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Guida B, Cataldi M, Memoli A, Trio R, di Maro M, Grumetto L, Capuano I, Federico S, Pisani A, Sabbatini M. Effect of a Short-Course Treatment with Synbiotics on Plasma p-Cresol Concentration in Kidney Transplant Recipients. J Am Coll Nutr 2017; 36:586-591. [PMID: 28895794 DOI: 10.1080/07315724.2017.1334602] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE We evaluated whether a short-term course with synbiotics may lower plasma p-Cresol concentrations in kidney transplant patients (KTRs) who accumulate this uremic toxin both because of increased production by their dysbiotic gut microbiome and because of reduced elimination by the transplanted kidneys. METHODS Thirty-six KTRs (29 males, mean age 49.6 ± 9.1 years) with transplant vintage > 12 months, stable graft function, and no episode of acute rejection or infection in the last 3 months were enrolled in this single-center, parallel-group, double-blinded, randomized (2:1 synbiotic to placebo) study. Synbiotic (Probinul Neutro, CadiGroup, Rome, Italy) or placebo was taken at home for 30 days, as 5 g powder packets dissolved in water three times a day far from meals. The main outcome measure was the decrease in total plasma p-Cresol measured by high-performance liquid chromatography at baseline and after 15 and 30 days of placebo or synbiotic treatment. RESULTS After 15 and 30 days of treatment, plasma p-Cresol decreased by 40% and 33% from baseline (both p < 0.05), respectively, in the synbiotic group, whereas it remained stable in the placebo group. After 30 days of treatment, no significant change was observed in either group in renal function, glycemia, plasma lipids, or albumin concentration. Treatment was well tolerated and did not induce any change in stool characteristics. CONCLUSION The results of this pilot study suggest that treatment with synbiotics may be effective to lower plasma p-Cresol concentrations in KTRs. Prospective larger scale, longer term studies are needed to establish whether cardiovascular prognosis could also be improved with this nutritional intervention.
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Affiliation(s)
- Bruna Guida
- a Department of Clinical Medicine and Surgery, Physiology Nutrition Unit , Federico II University of Naples , Naples , Italy.,b Federico II University Hospital , Naples , Italy
| | - Mauro Cataldi
- b Federico II University Hospital , Naples , Italy.,c Department of Neuroscience, Reproductive Sciences and Dentistry, Division of Pharmacology , Federico II University of Naples , Naples , Italy
| | - Andrea Memoli
- b Federico II University Hospital , Naples , Italy.,d Department of Public Health, Nephrology Section , Federico II University of Naples , Naples , Italy
| | | | - Martina di Maro
- a Department of Clinical Medicine and Surgery, Physiology Nutrition Unit , Federico II University of Naples , Naples , Italy.,b Federico II University Hospital , Naples , Italy
| | - Lucia Grumetto
- e Department of Pharmaceutical and Toxicological Chemistry , Federico II University of Naples , Naples , Italy
| | - Ivana Capuano
- b Federico II University Hospital , Naples , Italy.,d Department of Public Health, Nephrology Section , Federico II University of Naples , Naples , Italy
| | - Stefano Federico
- b Federico II University Hospital , Naples , Italy.,d Department of Public Health, Nephrology Section , Federico II University of Naples , Naples , Italy
| | - Antonio Pisani
- b Federico II University Hospital , Naples , Italy.,d Department of Public Health, Nephrology Section , Federico II University of Naples , Naples , Italy
| | - Massimo Sabbatini
- b Federico II University Hospital , Naples , Italy.,d Department of Public Health, Nephrology Section , Federico II University of Naples , Naples , Italy
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Belfiore A, Cataldi M, Minichini L, Aiello ML, Trio R, Rossetti G, Guida B. Short-Term Changes in Body Composition and Response to Micronutrient Supplementation After Laparoscopic Sleeve Gastrectomy. Obes Surg 2016; 25:2344-51. [PMID: 25948283 DOI: 10.1007/s11695-015-1700-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND We evaluated dietary intakes, body composition, micronutrient deficiency, and response to micronutrient supplementation in 47 patients before and for 6 months after laparoscopic sleeve gastrectomy (LSG). METHODS Before, 3, and 6 months after LSG, we measured dietary intakes with food-frequency questionnaires, body composition with bioimpedance analysis (BIA) and bioelectrical vector analysis (BIVA), and plasma concentrations of iron, Zn, water-, and lipo-soluble vitamins. RESULTS After LSG, energy intake significantly decreased and patients lost weight, fat mass, and free-fat mass. BIVA showed a substantial loss of soft tissue body cell mass (BCM) with no change in hydration. Before surgery, 15 % of patients were iron deficient, 30 % had low levels of zinc and/or water-soluble vitamins, and 32 % of vitamin 25(OH)-D3. We treated iron deficiency with ferrous sulfate, isolated folate deficiency with N5-methyiltetrahydrofolate-Ca-pentahydrate, and deficiencies in vitamin B1, B12, or Zn, with or without concomitant folate deficiency, with multivitamin. No supplementation was given to vitamin 25(OH)-D3 deficient patients. At first follow-up, 7 % of patients developed new deficiencies in iron, 7 % in folic acid (n = 3), and 36 % in water-soluble vitamins and/or zinc whereas no new deficit in vitamin 25(OH)-D3 occurred. At final follow-up, deficiencies were corrected in all patients treated with either iron or folate but only in 32 % of those receiving multivitamin. Vitamin 25(OH)-D3 deficiency was corrected in 73 % of patients even though these patients were not supplemented. CONCLUSION LSG-induced weight loss is accompanied by a decrease in BCM with no body fluid alterations. Deficiencies in water-soluble vitamins and Zn respond poorly to multivitamin supplementation.
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Affiliation(s)
- A Belfiore
- Department of Clinical Medicine and Surgery, Division of Physiology, Federico II University of Naples, Via Pansini n 5, 80131, Naples, Italy
| | - M Cataldi
- Division of Pharmacology, Department of Neuroscience, Reproductive and Odontostomatologic Sciences, Federico II University of Naples, Naples, Italy
| | - L Minichini
- Department of Clinical Medicine and Surgery, Division of Physiology, Federico II University of Naples, Via Pansini n 5, 80131, Naples, Italy
| | - M L Aiello
- Department of Clinical Medicine and Surgery, Division of Physiology, Federico II University of Naples, Via Pansini n 5, 80131, Naples, Italy
| | - R Trio
- Department of Clinical Medicine and Surgery, Division of Physiology, Federico II University of Naples, Via Pansini n 5, 80131, Naples, Italy
| | - G Rossetti
- Division of General Surgery, Department of Surgery, Second University of Naples, Naples, Italy
| | - B Guida
- Department of Clinical Medicine and Surgery, Division of Physiology, Federico II University of Naples, Via Pansini n 5, 80131, Naples, Italy.
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13
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Cataldi M, di Geronimo O, Trio R, Scotti A, Memoli A, Capone D, Guida B. Utilization of antihypertensive drugs in obesity-related hypertension: a retrospective observational study in a cohort of patients from Southern Italy. BMC Pharmacol Toxicol 2016; 17:9. [PMID: 26980335 PMCID: PMC4793753 DOI: 10.1186/s40360-016-0055-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 02/15/2016] [Indexed: 12/28/2022] Open
Abstract
Background Although the pathophysiological mechanisms of arterial hypertension are different in obese and lean patients, hypertension guidelines do not include specific recommendations for obesity-related hypertension and, therefore, there is a considerable uncertainty on which antihypertensive drugs should be used in this condition. Moreover, studies performed in general population suggested that some antihypertensive drugs may increase body weight, glycemia and LDL-cholesterol but it is unclear how this impact on drug choice in clinical practice in the treatment of obese hypertensive patients. Therefore, in order to identify current preferences of practitioners for obesity-related hypertension, in the present work we evaluated antihypertensive drug therapy in a cohort of 129 pharmacologically treated obese hypertensive patients (46 males and 83 females, aged 51.95 ± 10.1 years) that came to our observation for a nutritional consultation. Methods Study design was retrospective observational. Differences in the prevalence of use of the different antihypertensive drug classes among groups were evaluated with χ2 square analysis. Threshold for statistical significance was set at p < 0.05. Results 41.1 % of the study sample was treated with one, 36.4 % with two and the remaining 22.5 % with three or more antihypertensive drugs. In patients under single drug therapy, β-blockers, ACEIs and ARBs accounted each for about 25 % of prescriptions. The prevalence of use of β-blockers was about sixfold higher in females than males. Diuretics were virtually never used in monotherapy regimens but were used in more than 60 % of patients on dual antihypertensive therapy and in all patients assuming three or more drugs. There was no significant difference in the prevalence of use of any of the aforementioned drugs among patients with obesity of type I, II and III or between patients with or without metabolic syndrome. Conclusions Our data show that no first choice protocol seems to be adopted in clinical practice for the treatment of obesity-related hypertension. Importantly, physicians do not seem to differentiate drug use according to the severity of obesity or to the presence of metabolic syndrome or to avoid drugs known to detrimentally affect body weight and metabolic profile in general population.
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Affiliation(s)
- Mauro Cataldi
- Division of Pharmacology, Department of Neuroscience, Reproductive and Odontostomatologic Sciences, Federico II University of Naples, Via Pansini n°5, Naples, 80131, Italy.
| | - Ornella di Geronimo
- Division of Physiology, Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Rossella Trio
- Division of Physiology, Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Antonella Scotti
- Division of Physiology, Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Andrea Memoli
- Division of Nephrology, Department of Public Health, Federico II University of Naples, Naples, Italy
| | - Domenico Capone
- Division of Pharmacology, Department of Neuroscience, Reproductive and Odontostomatologic Sciences, Federico II University of Naples, Via Pansini n°5, Naples, 80131, Italy
| | - Bruna Guida
- Division of Physiology, Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
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14
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Nutritional Status in Japanese Renal Transplant Recipients With Long-term Graft Survival. Transplant Proc 2015; 47:367-72. [DOI: 10.1016/j.transproceed.2014.10.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 10/05/2014] [Indexed: 12/13/2022]
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15
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Guida B, Germanò R, Trio R, Russo D, Memoli B, Grumetto L, Barbato F, Cataldi M. Effect of short-term synbiotic treatment on plasma p-cresol levels in patients with chronic renal failure: a randomized clinical trial. Nutr Metab Cardiovasc Dis 2014; 24:1043-1049. [PMID: 24929795 DOI: 10.1016/j.numecd.2014.04.007] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 04/04/2014] [Accepted: 04/23/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND AIMS In patients with chronic kidney disease (CKD), alterations in gut microbiome are posited to be responsible for gastrointestinal symptoms and generation of p-cresol, a uremic toxin that has been associated with CKD progression and cardiovascular mortality. This pilot study investigated whether Probinul-neutro®, a synbiotic that normalizes intestinal microflora, may lower plasma p-cresol concentrations and reduce gastrointestinal symptoms in non-dialyzed CKD patients. METHODS AND RESULTS This was a double-blind, randomized placebo-controlled trial. Thirty patients on 3-4 CKD stages were randomized to receive either Probinul neutro® or placebo for 4 weeks. Total plasma p-cresol concentration was assessed at baseline, and 15 and 30 days after treatment start. At the same study times, ease and frequency of defecation, upper and lower abdominal pain, stool shape, borborygmi, and flatus were quantified by subjective assessment questionnaires. Compared to baseline total plasma p-cresol median concentrations on 15th and 30th day were significantly lower in patients receiving Probinul-neutro® (2.31 and 0.78 vs. 3.05 μg/ml, p < 0.05; n = 18); no changes of plasma p-cresol concentrations were recorded in placebo-treated patients. No significant changes in gastrointestinal symptoms were observed during the study both in Probinul-neutro®-treated and placebo-treated patients. CONCLUSION Probinul-neutro® lowered total plasma p-cresol concentrations but did not ameliorate gastrointestinal symptoms in non-dialyzed CKD patients. Because high plasma concentrations of p-cresol in early phases of CKD are predictive of progression to end-stage renal disease, the results of our study suggest that synbiotics deserve attention as possible tools to delay CKD progression towards end-stage renal disease (ESRD). CLINICALTRIALSGOV IDENTIFIER NCT02008331.
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Affiliation(s)
- B Guida
- Division of Physiology, Department of Clinical Medicine and Surgery, Federico II University of Naples, Italy.
| | - R Germanò
- Division of Physiology, Department of Clinical Medicine and Surgery, Federico II University of Naples, Italy
| | - R Trio
- Division of Physiology, Department of Clinical Medicine and Surgery, Federico II University of Naples, Italy
| | - D Russo
- Division of Nephrology, Department of Public Health, Federico II University of Naples, Italy
| | - B Memoli
- Division of Nephrology, Department of Public Health, Federico II University of Naples, Italy
| | - L Grumetto
- Department of Pharmaceutical and Toxicological Chemistry, Federico II University of Naples, Italy
| | - F Barbato
- Department of Pharmaceutical and Toxicological Chemistry, Federico II University of Naples, Italy
| | - M Cataldi
- Division of Pharmacology, Department of Neuroscience, Reproductive and Odontostomatologic Sciences, Federico II University of Naples, Italy
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Guida B, Napoleone A, Trio R, Nastasi A, Balato N, Laccetti R, Cataldi M. Energy-restricted, n-3 polyunsaturated fatty acids-rich diet improves the clinical response to immuno-modulating drugs in obese patients with plaque-type psoriasis: a randomized control clinical trial. Clin Nutr 2014; 33:399-405. [DOI: 10.1016/j.clnu.2013.09.010] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 09/16/2013] [Accepted: 09/17/2013] [Indexed: 11/28/2022]
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